R Ted Roberts DDS PA

Primary specialty

DentistTaxonomy code 122300000X

License

147071 Issued in MS

Legal business name

R TED ROBERTS DDS PA

Practice address

632 Friars Point Road
Clarksdale, MS 38614

Phone

(662) 624-6862

Fax

(662) 624-5985

NPI assigned

Sep 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

R Ted Roberts, DDS PA

Title

President

Phone

(662) 624-6862

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Theodore Roberts

  • General Practice Dentistry
  • Clarksdale, MS
  • NPI 1518083948
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164524328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 FRIARS POINT ROAD",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "38614",
            "telephone_number": "662-624-6862",
            "fax_number": "662-624-5985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 FRIARS POINT ROAD",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "38614",
            "telephone_number": "662-624-6862",
            "fax_number": "662-624-5985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R TED ROBERTS DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "TED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-624-6862",
        "authorized_official_credential": "DDS PA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "147071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shirley Brianne Pounders, PHARMD
• Preferred Care Developmental Centers of Ms I, Inc. (Delta Manor)
• Kristalin Young Presley, FNP
• Professional Pharmacy Services, Inc
• R Andrew Packard MD PC
• Rad-One, PA
• Aisha Ragland
• Anu Ramgoolam, RD
• Preston Deshawn Ratiff III, PT
• RCG Mississippi, Inc. (Renal Care Group Clarksdale)

• Dentist in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.